molly dear abshire wright abshire, attorneys bellaire, texas
TRANSCRIPT
Planning for Public Benefits
Skills Training for Estate PlannersNew York Law SchoolNew York, New York
July 8-13, 2012
Molly Dear AbshireWright Abshire, Attorneys
Bellaire, Texas
Demographics
20% of U.S. population is disabled at any given time.
10% of U.S. population is severely disabled and relies on benefit programs to provide for basic needs.
Need for planning for public benefits is growing.
Role of Public Benefits Attorney
Evaluates funding options for financing LTC
Assists in qualification for public benefits
Counsels regarding available programs
Preserves existing public benefitsAdvises regarding estate planning
documents and prepares same
Estate Planning Documents for Disabled Individuals
If capacity: Financial Power of Attorney Medical Directives Will and/or Trust
If no capacity: Guardianship/Conservatorship
Three Ways to Finance Long-Term Care
Private payLong-term care insurancePublic benefits
Medicare Medicaid VA Benefits
Medicaid vs. Long-Term Care Insurance
Most people feel they will never need LTC
When the need arises many cannot qualify for LTC insurance & premiums may be cost-prohibitive
Many mistakenly believe that Medicare will cover LTC needs
Long-Term Care Partnership Programs Not counted as income to the Medicaid
recipient Benefits paid = assets can exclude
Common Causes of Medicaid Eligibility
Rising costs of care for disabled individuals
Unavoidable ImpoverishmentProtection of the “Community
Spouse”Private insurance exhaustedUninsurability
Public Benefits Only Covers Basic Needs
Many personal needs left uncovered Clothing Dental care Transporation
Trust planning can help close the gap
Ethical Issues in Planning for Public Benefits
Identify the clientAvoiding fraudDiligent representation
Malpractice for failing to preserve public benefits
Client capacity and giftingMedicaid planning by non-attorneys
The Affordable Care Act (Health Care Reform)
Enacted March 23, 2010, fully implemented by Fall of 2014
Expansion of Medicaid benefits to qualified lower income retirees, effective in 2014, states may opt out.
Federal High Risk Insurance Program
Social Security Disability Insurance
Monthly cash assistance programFor qualified individuals who are
disabled before age 65Worked appropriate number of
quartersMust meet disability criteriaNon-means tested benefit
Medicare
Federal Health Insurance Program80/20 planFor eligible individuals 65+ and SSDI
beneficiaries after 24 monthsLifetime limitsNo LTCNon-means tested benefit
Four Parts of Medicare
Part A = in-patient services, home health, hospice and limited SNF
Part B = doctor chargesPart C = Medicare Advantage HMOPart D = voluntary drug plan
Medigap Insurance
Medicare has deductibles, co-pays and premiums
Without Medigap, not 100% insuredChoice of provider, but government
regulatedOpen enrollment period
Military and Civil Service Survivor Benefits
For adult children with disabilitiesProvides 55% of base pay divided by
eligible childrenTRICARE health coverageNon-means tested benefit
Disability Compensation
Two Types: Service Connected Disability
Compensation – injury, illness or aggravation of a pre-existing condition during active duty, non-means tested benefit
Non-Service-Connected Disability Pension – low income disability payments, means-tested benefit
Service Connected Disability Compensation
Disability contracted during active duty (no wartime requirements)
Veteran must not have been discharged dishonorably
Injury must not be the result of misconduct
Once disability is determined, a rating must be assigned
Non-Service Connected Disability Pension
Disability does not have to be service connected
Don’t have to be retired militaryNo requirement for combatMust meet income and net worth
requirements
Supplemental Security Income
Federal cash assistance program $698/month individual $1,048/month couple
Provides minimum level of income for individuals with disabilities
Means-tested benefit
Supplemental Security Income, cont.
To be eligible person must be: Age 65 or older or blind or disabled, U.S. Citizen or qualified alien, and Not a resident of public institute.
SSI Eligibility
Income limitationResource limitation
<$2k for single individual in countable resources
Excluded resources = home, car, prepaid funeral and household goods
In-Kind Support and Maintenance
ISM = food & shelterLesser of $ for $ reduction or 1/3
reduction of SSIExample: 1/3 reduction = [$698 x
1/3 = $292.67 + $20 disregarded income = $252.67]
Medicaid
Joint federal and state funded program for medical services
Means-tested benefitStates administer Medicaid 3
different ways: 209b states SSI states 1634 states
209b States
Example: ConnecticutUse at least one eligibility criteria
more restrictive than SSI program
SSI States
Example: Alaska If eligible for $1 of SSI, then eligible
for MedicaidStates determine eligibility
1634 States
Example: New York & TexasUse SSI eligibility, if eligible for $1 of
SSI, then eligible for MedicaidSSA determines eligibility
Medicaid Services
Hospital – in-patient & out-patient Physician services Physical therapy RX SNF Home and community Community supported living arrangements Personal care services Case management services Emergency care
Medicare Cost-Sharing Programs
For low-income Medicare beneficiaries
Vary according to income, Medicaid states and institutional status
May pay deductibles, premiums and co-pays of Medicare
Medicaid Long-Term Care Programs
Nursing Home MedicaidWaiver ProgramsCommunity Based ServicesPersonal Care Services
Three Prongs of Eligibility Criteria for LTC Medicaid
Categorical Requirements US Citizen/lawful alien 65 years of age or older, blind or
disabled Medical necessity Medicaid facility, Medicaid bed
Income TestResource Test
Transfer of Asset Penalty
Cannot give assets away and qualify for means-tested public benefits
5 year look back period for all statesPenalty rules vary by stateDisclaimer not okay
Purpose and Nature of Transfer Penalties for Means-Tested Benefits
If there were no restrictions, many individuals would become eligible for Medicaid by giving their assets away
The federal statute requires states to penalize transfers for less than fair market value
In Texas, the transfer penalty affects payments for institutional facility services and eligibility for home and community based waiver programs
Medicaid Estate Recovery Program (“MERP”)
Pursuant to OBRA ‘93States required to recoup funds
expended on Medicaid recipients at death
MERP often affects homestead
Housing Choice Voucher Program (“Section 8”)
Federal housing subsidyMeans-tested governmental benefitSNT not considered an asset for
eligibility purposes
Low-Income Disability Payments Eligibility for Veterans
Meet a needs based test determining inadequate income for adequate care
Suffer from a permanent and total disability (100%) rating
Veteran must not have been discharged dishonorably
Must not be the result of misconductServed at least ninety consecutive
days, with at least one day during wartime
Low-Income Disability Payments Eligibility for Veterans
Veterans with low incomes who are over age 65 are considered disabled
Unreimbursed medical expenses may reduce countable income
Low-Income Disability Payments Surviving Spouse of a Veteran
A surviving spouse is entitled to a lower pension, VA calls a “death benefit”
The Veteran must have met the previous requirements
The surviving spouse has not remarried
And, meets the requirements for the level of compensation
Low-Income Disability Eligibility Computation of Net Worth
The estate of the Veteran must be insufficient to support the Veteran
The net worth is the fair market value of all real and personal property
Except for the homestead and value of personal items within the homestead
Low-Income Disability Eligibility Computation of Net Worth
Case by Case analysisNo set amount or limitBased on actuarial life expectancy
and shortfall$80,000 fallacy
Interaction of Low Income Disability Payments and Medicaid
Many elderly Vets and spouses may qualify
Allows elderly Vets to afford care at home or assisted living
Could be used to pay for care during Medicaid Penalty Period
Monthly cash assistanceMeans-tested benefit Beware of penalty period
Special Monthly Payments
Aid and Attendance – for Veterans who are unable to perform activities of daily living without assistance
Housebound Allowances – for Veterans who are permanently housebound and who meet the requirements for non-service connected disability pension
VA Health Care System
Largest healthcare network in the country
Service requirementsFinancial eligibility requirementsEnrollment – 10-10EZPriority/ Status Groups
Benefits – Basic Package
Preventative Care ServicesAmbulatory (out-patient) Diagnostic
and TreatmentHospital (in-patient) Diagnostic and
TreatmentMedication and SuppliesFederal & State Veterans’ Nursing
Homes
Supplemental Needs Trusts (“SNTs”)
Most common tool to protect resources
May be Self-settled Third-party settled
They supplement (but do not supplant) public benefits.
Who Needs a SNT?
Individuals who are disabled and need public benefits.
Family members of a disabled person who needs to maintain public benefits.
SNTs to Supplement NOT Supplant
SUPPLANTING Food Shelter Medical items or
services paid by Medicaid
SUPPLEMENTING Medical needs not
covered by Medicaid
Social needs Recreational needs Educational
expenses
Self-Settled Trusts
2 types: Special Needs Trust [(d)(4)(A)] Pooled Special Needs Trust [(d)(4)
(C)]
Self-Settled SNT (d)(4)(A)
65 y.o. beneficiary’s own moneyCorporate trusteePayback provisionSettlor = parent, grandparent,
guardian or court Irrevocable
Self-Pooled SNT (d)(4)(C)
Beneficiary’s own moneyShared corporate trustee/
administered by non-profitPayback provision Irrevocable
Third-Party Settled Trusts
Testamentary or Inter-VivosFunded with third party fundsNot a resource, unless client can
revoke the trust or direct use of its assets for his own support and maintenance
Distributions to/for client can be countable income (unless for medical/social purposes)
Planning With Trusts
Self-Settled Trusts v. Third-Party Trusts Self-Settled Trusts: funded with the
beneficiary’s own money Third-Party Trusts: funded with other
people’s moneyAlways ask yourself: where is the
money coming from to fund this trust; not originally, but just before funding
SNT Planning Opportunity
Elderly clients with capacity and I Love You Wills Leave estate to a SNT for benefit of
surviving spouse Partition and transfer
SNT Planning Opportunity
Client is parent/grandparent of disabled child Inter vivos or testamentary third party
SNT Crummey provisions if taxable estate
SNT Planning Opportunity
Disabled spouse is divorcing Consider funding SNT
Disabled child’s parents divorcing Review effect of child support Consider funding SNT
SNT Planning Opportunity
Elderly client with disabled child needs Medicaid eligibility Consider funding sole-benefit trust with
SNT provisions for disabled child Immediate eligibility for client, continued
eligibility for disabled child
SNT Planning Opportunity
Client is receiving personal injury recovery Self-settled SNT or pooled trust Mandatory distribution language Corporate trustee
SNT Planning Opportunity
Client is receiving inheritance Self-settled SNT or pooled trust Mandatory distribution language Corporate fee except in rare situation
Alternatives to SNT
If trust is cost prohibitive, consider alternative action
Spend down excess resourcesPurchase exempt resources
State Requirements
SSI POMS standards plus some states impose additional requirements
States have authority to monitor administration of and distributions from SNTs
Drafting (d)(4)(c) SNTs
Meet POMS requirements.Some states have non-profits who
have formed pooled trusts.Example: Texas has one pooled trust:
ARC of Texas SNT. New York has many pooled trusts.
Drafting Third-Party SNTs
IrrevocableNo support languageDistribution provisionsTermination clauseNo payback provision
Third-Party SNTs & Eligibility
Corpus not a countable asset, unless client – Can revoke the trust; or Direct use of trust assets for his/her own
support & maintenanceDistributions to/or client are
countable income (if such income is ordinarily counted)
Other distributions do not affect client’s eligibility
Strict SNT
Distributions restricted to goods/services that do not count as income (no cash, food, or shelter)
Broad SNT
Any distribution is allowed that will not actually disqualify client for benefits.
If client not on benefits, distribution for cash, food and shelter okay.
Discretion to Reduce Benefits
Trustee may make distributions that result in in-kind support & maintenance (“ISM”), which reduces SSI payments, but does not eliminate benefits.
Distributions for room and board, resulting ISM up to PMV ($252.67) okay.
Totally Discretionary Trust
Distributions are totally at trustee’s discretion
Trustee may make distributions in any amount & for any purpose
In some states (not Texas) it automatically disqualifies client for Medicaid
Texas Medicaid evaluates each distribution
SNT Administration
Notification to SSA Notification to state agency Distribution advice
$ for $ reduction ISM▪ Food▪ Mortgage payments▪ Rent▪ Real property taxes▪ Utilities
Allowable Trust Distributions
Attendant CareMedical supplies and equipmentDentalElectronic equipmentLegal and accounting feesEntertainment, recreation, short
vacationNon-food grocery itemsTelephone and cable expensesClothing
Litigation Aspects
Self-settled SNTs funded with inheritances, excess funds and proceeds from PI claims
Resolve Medicare claims, Medicaid liens
Consider annuity structure tie-in to SNT